Provider Demographics
NPI:1144567843
Name:EASTPOINTE MEDICAL PHARMACY LLC
Entity Type:Organization
Organization Name:EASTPOINTE MEDICAL PHARMACY LLC
Other - Org Name:MEDPOINTE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM D
Authorized Official - Prefix:
Authorized Official - First Name:GHAZI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSAFARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-533-2835
Mailing Address - Street 1:22640 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2624
Mailing Address - Country:US
Mailing Address - Phone:586-533-2835
Mailing Address - Fax:586-533-2831
Practice Address - Street 1:22640 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2624
Practice Address - Country:US
Practice Address - Phone:586-533-2835
Practice Address - Fax:586-533-2831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1144567843Medicaid